Megna Matteo, Patruno Cataldo, Balato Anna, Rongioletti Franco, Stingeni Luca, Balato Nicola
Department of Dermatology, University of Naples Federico II, Naples, Italy.
Department of Advanced Biomedical Sciences, Dermatology Unit, University of Naples Federico II, Naples, Italy.
Arch Dermatol Res. 2017 Aug;309(6):443-452. doi: 10.1007/s00403-017-1739-y. Epub 2017 Apr 21.
Atopic dermatitis (AD) is a chronic, recurrent, inflammatory skin disease which predominantly affects children. However, AD may persist until adulthood (persistent AD), or directly start in adults (adult-onset AD). AD often shows a non-flexural rash distribution, and atypical morphologic variants in adults and specific diagnostic criteria are lacking. Moreover, adult AD prevalence as well as detailed data which can characterize persistent vs adult-onset subtype are scant. The aim of this study was to investigate on the main features of adult AD particularly highlighting differences between persistent vs adult-onset form. An Italian multicentre observational study was conducted between April 2015-July 2016 through a study-specific digital database. 253 adult AD patients were enrolled. Familiar history of AD was negative in 81.0%. Erythemato-desquamative pattern was the most frequent clinical presentation (74.3%). Flexural surface of upper limbs was most commonly involved (47.8%), followed by eyelid/periocular area (37.9%), hands (37.2%), and neck (32%). Hypertension (7.1%) and thyroiditis (4.3%) were the most frequent comorbidities. A subgroup analysis between persistent (59.7%) vs adult-onset AD patients (40.3%) showed significant results only regarding AD severity (severe disease was more common in persistent group, p < 0.05), itch intensity (higher in adult-onset disease), and comorbidities (hypertension was more frequent in adult-onset group, p < 0.01). Adult AD showed uncommon features such as significant association with negative AD family history and lacking of association with systemic comorbidities respect to general population. No significant differences among persistent vs adult-onset subgroup were registered except for hypertension, itch intensity, and disease severity.
特应性皮炎（AD）是一种慢性、复发性炎症性皮肤病，主要影响儿童。然而，AD可能会持续到成年期（持续性AD），或直接在成人中发病（成人发病型AD）。AD常表现为非屈侧皮疹分布，成人中缺乏非典型形态学变异及特定的诊断标准。此外，成人AD的患病率以及能够区分持续性与成人发病型亚型的详细数据很少。本研究的目的是调查成人AD的主要特征，特别强调持续性与成人发病型之间的差异。通过一个特定研究的数字数据库，于2015年4月至2016年7月在意大利进行了一项多中心观察性研究。纳入了253例成人AD患者。81.0%的患者AD家族史为阴性。红斑脱屑型是最常见的临床表现（74.3%）。上肢屈侧最常受累（47.8%），其次是眼睑/眼周区域（37.9%）、手部（37.2%）和颈部（32%）。高血压（7.1%）和甲状腺炎（4.3%）是最常见的合并症。持续性AD患者（59.7%）与成人发病型AD患者（40.3%）的亚组分析显示，仅在AD严重程度（持续性组严重疾病更常见，p<0.05）、瘙痒强度（成人发病型疾病中更高）和合并症（成人发病型组高血压更常见，p<0.01）方面有显著结果。成人AD表现出不常见的特征，如与AD家族史阴性有显著关联，且与一般人群相比缺乏与全身性合并症的关联。除高血压、瘙痒强度和疾病严重程度外，持续性与成人发病型亚组之间未发现显著差异。
